Curriculum

We have exciting news! ARMC Emergency Medicine Residency Program and ARMC Internal Medicine Residency Program (both ACGME accredited residency programs) have joined forces to create an EM/IM Combined training program that was recently approved by both the American Board of Emergency Medicine (ABEM) and the American Board of Internal Medicine (ABIM). It will be a 5 year long program that will allow residents who complete it to become eligible for both ABEM and ABIM specialty boards upon successful completion of this combined program.

 

We will not be entering a separate EM/IM NRMP match for this year. However, we plan to allow one incoming EM resident and one IM incoming intern to enter this combined program. This is in compliance with the regulations set forth by NRMP, ABEM, and ABIM. Please see below for more information regarding the proposed 5 year curriculum and the statement published by ABEM and ABIM regarding the EM/IM combined program. For more information, please reach out to EMResidency@armc.sbcounty.gov or davalosa1@armc.sbcounty.gov.

At ARMC, the combination of a hands-on approach, strong didactic curriculum, research, and committed faculty make for a well-rounded resident training program. Learning is obtained on a case-by-case basis with bedside teaching viewed as a crucial instrument for education. There are five hours of scheduled weekly didactics, which include morbidity and mortality conference, resident lecture series, the Academic Life in Emergency Medicine’s Approved Instructional Resource modules and trauma grand rounds with the surgery department. Medical research is encouraged at ARMC, with multiple on-going research projects throughout the year. Residents have presented at regional conferences and are published in peer-reviewed journals. Attending physicians give procedure workshops, as well as oral and written board review. Additionally, outside guest speakers periodically provide lectures on various topics.

The curriculum is set up as a PGY 1-3 program. The EM Resident will do 10 or 12 hour shifts during their ARMC EM rotations. Most shifts are 7-7. When off service, residents adhere to the schedule for that service.

The ARMC ED is divided into sections called “pods,” each of which have between eight and eleven beds. The more senior residents are given autonomy to run each pod with direct supervision from an attending physician. The more junior residents are paired up with a senior resident or attending. Residents have ample opportunity to do student teaching and mentoring during shifts.

Recently, the ED was voted the best rotation in the hospital by students and residents. Click on the link below to see an overview of our program highlights.

Program Highlights

PGY-1

• Emergency Medicine:  5.5 months
• Internal Medicine:  1 month
• Surgery:  1 month
• Orthopedics:  0.5 month
• Pediatrics:  0.5 month
• Obstetrics:   0.5 month
• Anesthesia:   0.5 month
• Medical Intensive Care Unit:   1 month
• Research:   0.5 month
• Vacation:  1 month

PGY-1’s will obtain a diverse foundation of knowledge that will be crucial for their development in the following years. On the medicine service each resident will admit, manage, and discharge their own patients. They will also attend a daily morning report where case presentations are discussed among residents and attending physicians. On the surgery service each resident will split their time between the general surgery team and the trauma surgery team. They will learn to do chest tubes, central lines, and gain surgical experience. Residents participate in trauma alerts and activations, providing crucial initial evaluation and resuscitation of the injured patient.

PGY-2

• Emergency Medicine:  4.75 months
• Community EM:  1 month
• Pediatric EM:  1 month
• Medical Intensive Care Unit:   1 month
• Surgical Intensive Care Unit:   1 month
• Neonatal Intensive Care Unit:   0.75 month
• Emergency Medical Services:   0.5 month
• Elective:   1 month
• Vacation:  1 month

PGY-2’s begin to experience community Emergency medicine by rotating at St. Bernardine’s Medical Center. They also rotate through the pediatric emergency department at Loma Linda University Children Hospital. They will serve as senior residents on the MICU and SICU services. On the MICU service each resident manages an entire team, supervising two interns and two medical students. Residents manage critically ill patients with multiple medical problems and perform procedures such as intubations, central lines, arterial lines, and pulmonary artery catheterizations. Residents also become familiarized with “drips,” “pressors,” and mechanical ventilation. On the SICU/Trauma service, residents will directly manage severely injured trauma patients as well as the resuscitation of burn victims.

PGY-3

• Emergency Medicine:  8 months
• Community EM:  2 months
• Pediatric Intensive Care Unit:   1 month
• Vacation:  1 month

PGY-3’s are given more autonomy and are expected to develop their leadership skills as they begin overseeing and supervising the junior residents. They will continue their community emergency medicine experience at St. Bernardine Medical Center. In addition, residents will be a senior on the PICU service at Loma Linda University Children Hospital. 

Elective Options

• Ultrasound
• Wilderness Medicine
• Emergency Medical Services
• Research
• Administration

These electives are available at ARMC. Residents who have special interests not available at ARMC may make special arrangement on a case by case basis.

Bedside ultrasound is now an integral component of our ED. It is used for a variety of purposes. Examples include:

• Trauma
• Biliary disease
• Appendicitis
• Pericardial effusions
• Pneumothoraces
• Retinal detachments
• Echocardiogram
• Central lines
• Regional anesthesia
• Pregnancies
• Foreign bodies

Fellowship

• The ARMC EMS Fellowship is designed to provide the opportunity to become board eligible for the sixth subspecialty in Emergency Medicine.
  
• Emergency Medical Services (EMS) is a medical subspecialty that involves prehospital emergency patient care, including initial patient stabilization, treatment, and transport to hospitals in specially equipped ambulances or helicopters.
  
• The purpose of EMS subspecialty certification is to standardize physician training and qualifications for EMS practice, improve patient safety and enhance the quality of emergency medical care provided to patients in the prehospital environment, and facilitate further integration of prehospital patient treatment into the continuum of patient care.
  
• ARMC EM Residency now supports a one year EMS fellowship with class size of 2.